On the occasion of International Women’s Day 2023, Outlook Planet looks at why India is likely to miss the target for contraceptive use under SDG 3 for health despite an increase in the use of modern contraceptives for family planning
The most recent National Family Health Survey (NFHS) 5 (2019-21) shows that there has been an increase in the use of modern contraceptives for family planning from 47.8 per cent to 56.5 per cent - since the previous survey (NFHS-4, 2015-16). However, an analysis by The Lancet suggests India is likely to miss the target for contraceptive use under Sustainable Development Goal (SDG) 3 for health. The SDG indictor 3.7.1 aims to measure the progress on the proportion of women of reproductive age (aged 15-49 years) who have their need for family planning satisfied with modern methods. The indicator on family planning is one of the 19 indicators (out of a total of 30 indicators) India may miss. The other indicators include child marriage and partner violence, among many others.
Merits of family planning
Family planning is sometimes ignored in the development discourse. However, it has been recognised as one of the most cost-effective solutions for achieving gender equality and equity as it empowers women with the knowledge and agency to control their bodies and reproductive choices. It is a cross-sectoral investment which impacts all the 17 SDGs directly and indirectly, giving couples – especially women – the freedom to choose whether to have children, and when. It helps families optimise their resources. It leads to more agency for women, and promotes their participation in the workforce, thus empowering them and helping them find fulfilment.
The Lancet analysis also shows that India will not meet the targets on several other related indicators – on child marriage, teenage pregnancy and partner violence. It may reach the target on averting teenage pregnancy by 2039, while the target on ending child marriage may be achievable by 2045. Partner violence (physical) is projected to be achieved not in this century but the next. All of these impact family planning and reduce girls’ and women’s ability to take control of their lives.
Contraceptive choice
A reason why India’s family planning coverage is below par is because the focus of the family planning programme – the oldest in the world – has been on promoting female sterilisation more than other methods. Female sterilisation accounts for 67 per cent (NFHS-5) among all methods of family planning available. Low family planning coverage is also due to minimal role of men in taking this responsibility –male sterilisation (vasectomy) is a mere .3 per cent of all the family planning methods while condoms constitute 9.5 per cent, leaving 90 per cent of family planning burden on women.
It is important to accelerate the family planning programme and focus not just on female sterilisation but offer a basket of choices – the complete range of the family planning options available to couples. India added the Antara injectable contraceptive, Chhaya oral contraceptive pill, in 2017, which has low coverage even after five years of its launch. Even as the government rolls our long acting reversible contraceptives (LARCs), the existing contraceptives should be promoted.
At the same time, a monumental effort in enabling girls and women to get educated, delaying their marriage, and joining the workforce as empowered individuals, is required. Not meeting the family planning targets denotes hundreds of thousands of girls and women will not be able to realise their potential as they become young mothers. The pathways to women’s empowerment, achieving family planning, averting child marriage and teenage pregnancy, promoting girls’ education and skill development intersect and support each other. It is imperative that India makes holistic as well as focused investments for girls and women to make this country a better place for them.
(Poonam Muttreja is Executive Director, Population Foundation of India.)